Wandworth Local Health and Care Plan - October 2019

53 Live Well - Integration of physical and mental health approaches – what we will do Summary Description of the programme What will be different about our approach A person’s mental and physical health are intrinsically linked but the life expectancy for people with Serious Mental Illness is 15 – 20 years lower than the general population. This disparity in health outcomes is partly due to physical health needs being overlooked but also partly due to the lack of emphasis given to mental health and wellbeing. The Programme of work outlined below intends to bring pro-active care closer to home to support people to manage both their physical and mental health with equal emphasis There is a compelling case for delivering care in an integrated way to ensure that a person’s mental and physical health needs are met together. Our approach to integrating services is based on feedback from both the general and clinical communities in response to gaps or areas of improvement identified. Our ambition is to improve accessibility and address health inequalities for the benefit of the overall population of Wandsworth What will we do Description of initiative What will be the impact How will we measure success Physical Health Checks for people with Serious Mental Illness Primary care teams (GP’s) will be incentivised for carrying out 50% of the annual physical health assessments targets including follow-up care • Patients with a diagnosis of severe mental illness will live longer • Fewer patients will attend A&E and GP surgeries with chronic physical health problems. • GPs will be able to maintain close contact with their higher- risk mental health patients • SMI patient will benefit from peer support which can assist them to access vital medical assessment appointments and to receive healthy living lifestyle support to ensure that 60% of patients with SMI to have an annual health check (50% in primary care and 10% in secondary care) Talking Therapies (IAPT) In 2019-20 we will be increasing access to psychological support to 22% of the population estimated to have either anxiety and/or depression. Working alongside GP’s and the mental health providers we will seek opportunities to provide access to clinical support in less formal settings including GP Practices • Earlier diagnosis leading to higher recovery rates • Embedding the service within GP Practices and other informal settings will enable improve access from hard to reach groups such as men, and those from a BME background Success will be measured against national standards i.e: • Access = 22% • Recovery Rates = 50% • Access to first treatment = 75% of referrals in < 6 weeks • Access to second treatment = 95% in <18weeks IAPT Long Term Conditions Pathway Around 40% of people with depression and anxiety disorders also have a long-term physical health condition. By providing support to people with diabetes, COPD and Cardiovascular conditions the evidence shows that we can reduce the number of unnecessary hospital admissions as a result of these conditions, maintain positive wellbeing and also support people to manage their conditions better within the community setting • A multi disciplinary approach enhances whole team’s capability to provide more comprehensive, accessible and holistic care to patients • Promotes mental health awareness and faster diagnosis identifying and addressing a person’s needs more quickly and accurately can in turn reduce the number of frequent attenders and repeat assessments • Promotes coordination and encourages the development of a single jointly-developed care Success will be measured against national standards i.e: • Access = 22% • Recovery Rates = 50% • Access to first treatment = 75% of referrals in < 6 weeks • Access to second treatment = 95% in <18weeks • A reduction in A&E attendances and inpatient admissions CAHS Home Based Support Following pilots commissioned in 2019-20, it is proposed that a mental health support worker is commissioned to work alongside Central London Community Health Trust to identify patients with Long Term Conditions that could benefit from support with mental health needs • A multi disciplinary approach enhances whole team’s capability to provide more comprehensive, accessible and holistic care to patients • Promotes mental health awareness and faster diagnosis identifying and addressing a person’s needs more quickly and accurately can in turn reduce the number of frequent attenders and repeat assessments • Promotes coordination and encourages the development of a single jointly- developed care • Reduction in the number of unnecessary GP referrals and/or A&E Attendances The measures of success are to be confirmed but could include measures such as: • Improved confidence to manage their wellbeing • Reduction in London Ambulance conveyances • Reduction in the number if unnecessary A&E attendances